Patients caught in war of generic, branded drugs

Everyone loves freebies, and doctors are no exceptions. It begins with some teasers like a mug, a pen, a bag and then the value of these perks climb up to an expensive holiday, conference sponsorships and so on. As custodians of the nation’s prescription pads, doctors stand between patients and pharmaceutical companies. Their prescriptions indicating which medication — generic or branded — and for how long, affect drug sales.

So pharmaceutical companies focus their marketing budgets to give incentives to doctors so that they promote their “expensive” branded drugs.

The recent announcement of Prime Minister Narendra Modi hinting at rules for doctors to prescribe generic medicine seems like a move to end these cosy ties.

If implemented religiously, experts believe that the push to prescribe generic medicines will help reduce “over prescription” which will further bring down “out-of-pocket expenses”.

“The unhealthy nexus between doctors and pharma companies encourages over prescription of expensive medicines. Possible confusion or mistakes are reduced if all doctors use generic name when talking about and prescribing medicines,” says Leena Menghaney, head, South Asia, MSF Access campaign.

“However, this will require major behavioural change from the medical fraternity which mistakenly associates more expensive brands with quality,” Ms Menghaney says.

Even as the PM’s announcement is expected to break the perceived nexus between the pharmaceutical manufacturers and doctors to some extent, it is unclear how successful this latest push will be given the fact that this is not the first time that the government has stressed on prescribing the low-cost generic drugs.

In the past, numerous attempts to mandate generic drugs have gone futile. In 2016, the Medical Council of India (MCI) amended the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, directing government doctors to prescribe generic drugs.  

The amendment did lend some teeth to the regulation but the failure of generic prescription policy has once again brought the issue to fore.

A notable recent intervention in the policy could be another step in the same direction. The Union health ministry recently issued a draft gazette notification making it mandatory for the pharma companies to carry generic names of the drugs in bolder fonts than the brand name.

“Bringing in generic name prescriptions will be a pathbreaking step for the government. It will not only benefit the patients but the move will also strengthen the public health in the country,” says Ms Menghaney.

The sticking points for doctors, however, have been the unavailability of generic drugs and their quality.

“Prescribing generic drugs is a good idea but if there is no quality control then these generic drugs can harm immensely and may lead to new problems,” says Dr Anoop Misra, chairman, Fortis C-DOC Centre of Excellence for Diabetes, metabolic diseases and endocrinology.

“I am all for generic drugs but also concerned about the quality of these drugs. The quality has to be regulated,” says Dr Misra.

“The only way to assess quality is to ensure quality raw materials (API) and conduct an audit of the production facility where the medicine is produced following good manufacturing practices — and that is something the state FDAs have to strengthen,” says Menghaney.

“This regulation also need to be backed by laws to ensure that chemists stock and offer the more affordable brands of generic medicines to patients instead of offering branded medicines on which they get highest mark ups,” Ms Menghaney adds.